MK Living, Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

MK LIVING, INC

Practice address

17006 E Ohio Dr Apt 1-102
Aurora, CO 80017-3433

Phone

(720) 300-7719

NPI assigned

Aug 1, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Danise Machelle Polumbus

Title

Executive Director

Phone

(720) 300-7719

Specialties & licenses 6

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1114609088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7384 E PRINCETON AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802372386",
            "telephone_number": "720-300-7719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17006 E OHIO DR APT 1-102",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800173433",
            "telephone_number": "720-300-7719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MK LIVING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-01",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "POLUMBUS",
        "authorized_official_first_name": "DANISE",
        "authorized_official_middle_name": "MACHELLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "720-300-7719"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "347E00000X",
            "taxonomy_group": "",
            "desc": "Transportation Broker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naomi K Miyazawa, PA-C
• Cecelia Breslin Mizelle
• Sarah Anne Mizen-Halperin
• Philip B Mizuno, CFNP
• Chloe Mizusawa, CCC-SLP
• Cheryl Denese Mlcoch, LPC
• MLRL, Inc
• Mo Smiles LLC
• Moa LLC
• Eric Moberly, DPT

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Aurora, CO
• Providers in Aurora, CO by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.